"If I Take My Medicine, I Will Be Strong:" Evaluation of a Pediatric HIV Disclosure Intervention in Namibia
"If I Take My Medicine, I Will Be Strong:" Evaluation of a Pediatric HIV Disclosure Intervention in Namibia
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DOI：
10.1097/qai.0000000000000387
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发表时间：
2015-01-01
影响因子：
3.6
通讯作者：
Brandt, Laura
中科院分区：
文献类型：
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作者：
O'Malley, Gabrielle;Beima-Sofie, Kristin;Brandt, Laura
背景：尽管有已知的益处，但在撒哈拉以南非洲，只有一小部分感染艾滋病毒的儿童知道自己的状况，现有的披露干预措施有限。纳米比亚卫生和社会服务部制定并实施了一项多管齐下的干预措施，以支持卫生保健工作者和护理人员参与信息披露过程。方法：干预包括阶段性披露漫画书，儿童和照顾者准备评估工具，监测表格跟踪访问进展，HCW培训课程。我们对4家大型艾滋病毒诊所的35名卫生保健员和46名艾滋病毒阳性儿童的护理人员进行了定性访谈。访谈获得了有关干预措施吸收和影响的详细信息。医护人员还参与了一项自我效能感调查。结果：干预提高了HCW和照顾者对儿童信息披露的信心和沟通技巧。最有价值的干预成分是披露漫画书，它为逐步披露过程提供了结构、语言和指导。卫生保健工作者报告说，这大大减少了护理人员对披露的抵制。护理人员和卫生保健工作者都报告说，他们提高了对儿科患者的知识和能力，提高了儿童对艾滋病药物如何起作用的理解，增加了儿童对未来的希望，并提高了儿童对护理和治疗的依从性。医护人员自我效能调查发现，接受过培训的医护人员对自己参与披露过程的能力更有信心。结论：卫生保健工作者和护理人员高度认可该干预措施。鉴于解决非洲儿童艾滋病毒信息披露问题的紧迫性，以及当地生产的信息披露工具的实用性和低成本，这种方法可能在其他类似环境中有用。
Background: Despite known benefits, only a small proportion of HIV-infected children in sub-Saharan Africa know their status and limited disclosure interventions exist. Namibia's Ministry of Health and Social Services developed and implemented a multipronged intervention to support health care workers (HCWs) and caregivers in the disclosure process.Methods: The intervention included a staged disclosure cartoon book, child and caregiver readiness assessment tools, a monitoring form to track progress over visits, and HCW training curriculum. We conducted qualitative interviews with 35 HCWs and 46 caregivers of HIV-positive children at 4 high volume HIV clinics. Interviews elicited detailed information about intervention uptake and impact. HCWs also participated in a self-efficacy survey.Results: The intervention improved HCW and caregiver confidence and communication skills in pediatric disclosure. The most valuable intervention component was the disclosure cartoon book, which provided structure, language, and guidance for a gradual disclosure process. HCWs reported it greatly reduced caregiver resistance to disclosure. Both caregivers and HCWs reported improved knowledge and ability to support the pediatric patient, improved child understanding of how HIV medications work, increased child hopefulness for their future, and improved child adherence to care and treatment. HCW self-efficacy surveys found that HCWs who received training felt more confident in their ability to engage in the disclosure process.Conclusions: HCWs and caregivers highly endorsed the intervention. Given the urgency to address pediatric HIV disclosure in Africa, and the utility and low cost of the locally-produced disclosure tool, this approach may be useful in other similar settings.